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Anticoagulation

Studies have shown an increased risk of stroke in patients with atrial fibrillation. One of the most difficult aspects in the management of atrial fibrillation is deciding which type of anticoagulation to use to prevent thromboembolic events Over the past decade there have been several published risk factor based approaches to deciding which type of oral anticoagulation to use. The two most widely used are the CHADS2 and the CHA2DS2VASc risk scores.

The CHADS2 score allows us to predict the risk of stroke in patients with atrial fibrillation and guides us in the use of oral anticoagulants. The CHADS2 score was validated in a study published in JAMA in 2001 using 1,733 atrial fibrillation patients tracked through Medicare claims. In patients with a CHADS2 score of 0 to 1 aspirin is acceptable therapy. With a CHADS2 score of 2 or more, oral anticoagulation with warfarin or dabigatran is recommended. The CHADS2 schema, while easy to use, does not include all of the potential stroke risk factors. Major risk factors are: previous stroke or thromboembolism and age ≥75. Minor risk factors are: diabetes, hypertension, age 65-74, systolic heart failure (or moderate-severe left ventricular dysfunction), female gender and vascular disease. These factors are expressed in the CHA2DS2-VASc score.

Patients with a CHADS2 score of 2 or greater should be treated with oral anticoagulation (warfarin or dabigatran). In patients with a CHADS2 score of 1, aspirin or oral anticoagulation is recommended, and for a score of 0 aspirin alone is recommended.

If your physician would like to refer you for a consultation or you would like to make an appointment to speak with us concerning the treatment options available to you in our Atrial Fibrillation Center please call (201) 996-2997.